Radiologists Push Back on Reimbursement Cuts

John Commins, for HealthLeaders Media , April 12, 2013

Radiologists are complaining that their specialty has been the target of too many sticks and not enough carrots as the federal government looks for ways to control cost growth in Medicare.

The latest skirmish is pitched around the Centers for Medicare & Medicaid Services' 25% multiple procedure payment reduction to Medicare reimbursements for interpretations of advanced diagnostic imaging scans performed on the same patient in the same session. The rule, which took effect in January, applies across all physicians in a practice.

Geraldine McGinty, MD, chair of the American College of Radiology Commission on Economics, is the co-author of a study that she says refutes the government's assumptions that significant efficiencies in physician interpretation and diagnosis are gained when different providers interpret different medical imaging scans performed on the same patient.

"Medicare believes there are efficiencies so that when a subsequent service is performed, that the physician that is furnishing that subsequent service does not have to make the same effort they would have to make if there were no other services performed in the same session," McGinty says. "We don't believe that that is true and our paper clearly shows that it is not."

The study appears this week in the online edition of the Journal of the American College of Radiology.

The rule does not affect the number of scans ordered; only interpretation of scans already performed, and has been expanded to physical therapy, cardiovascular, and ophthalmology technical services as well.

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2 comments on "Radiologists Push Back on Reimbursement Cuts"

Mtb Walt (7/5/2013 at 8:52 PM)
Tibro Lushi, You say that the problem is that we pay for service in America. What else should we pay for? You do a job and you get paid for it. Your comment also indicates a fundamental misunderstanding of how imaging is reimbursed, as well as the many difficulties being faced by socialist health care systems... not least of which is quality of care. The radiologist is paid to provide the professional interpretation component of the exam. The owner of the machine (such as a hospital) is paid for providing the machine and taking the pictures. Radiologists have been cut 8 times in the last 6 years. This random 25% cut whose justification is refuted by scientific research has just been rammed through by Kathleen Sebelius, of the Obama administration that you so love. As a result, we have large numbers of lesser qualified foreign graduates flooding into radiology as the highly qualified American graduates avoid this foundering but essential field of medicine. Doctors fees make up about 15% of every medical dollar. So if you cut doctors 20% which will certainly result in a significant degradation quality doctors, you have cut only 3% from the medical dollar. That is equivalent to inflation for 1 year.

Tibro lushi (4/12/2013 at 11:47 AM)
The biggest problem in American healthcare is that payment is made per service. For example, the radiologist first gets paid to do the test and then gets paid to do the interpretation of the test. This happens separatedly for every test. Thankfully, Obamacare is moving us towards a more sane way to pay[INVALID]by diagnosis. If the patient has cancer, pay one amount to take care of that cancer, no matter how many tests and interpretations are needed. Europe moved to that long ago. Healthcare there is around 13% of GDP while the US is reaching 20%[INVALID]utterly unsustainable.




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